To the Editor.—Dr Hayward and colleagues1 emphasize that therapy in type 2 diabetes, especially
insulin therapy, was rarely effective in actual clinical practice in achieving
tight glycemic control. Few patients receiving insulin therapy reached commonly
proposed goals for near normalization of HbA1c levels. While overall,
60% had HbA1c levels of at least 8% (0.08), only 43% of the 690
patients treated with sulfonylureas and 18% of the 184 patients not receiving
any hypoglycemic medication in this health maintenance organization had HbA1c levels of at least 8% (0.08).